This original article was featured in the April 2025 issue of The American Chiropractor

Risk management in chiropractic practice extends beyond patient safety. It encompasses crucial treatment planning and financial management aspects that directly impact patient care and your practice’s long-term viability.  

Effective treatment planning is paramount for mitigating risk. Establishing clear and documented treatment goals with each patient is essential. These goals should be specific, measurable, achievable, relevant, and time-bound (SMART). When it comes to SMART goals, specificity is key. For instance, instead of “reduce pain,” a SMART goal would be “Reduce patient’s lower back pain by 3 points on a pain scale of 1-10 within 4 weeks. Documenting these goals clearly in the patient’s record, along with the rationale for the chosen treatment plan, provides a roadmap for care and demonstrates a thoughtful approach. Treatment plans must be regularly reviewed and adjusted based on patient progress and response. Scheduled re-evaluations are important to assess progress and modify the treatment plan as needed. This demonstrates a dynamic approach to care.

Informed consent and patient education are integral components of risk mitigation. Obtaining informed consent from patients, ensuring they understand the treatment plan, potential risks and benefits, and alternative treatment options, is ethical and legally necessary. Educating patients on their condition, treatment options and self-care strategies empowers them to participate in their care actively and can improve treatment outcomes.  Using layman’s terms, clear communication helps ensure patients genuinely understand the information. It is vital to answer patient questions patiently and thoroughly. Meticulous documentation of all patient interactions, including examinations, treatment procedures, patient progress notes, and any changes to the treatment plan, is vital for demonstrating the necessity and effectiveness of your treatment plan and can be crucial in defending your practice in the event of a claim.  

Sound financial management is another critical aspect of risk mitigation. Transparent financial policies, including clear communication of fees, payment options, and insurance policies, build trust with patients and minimize misunderstandings.  

The No Surprises Act ¹ mandates that healthcare providers provide patients with a Good-Faith Estimate (GFE) of expected out-of-pocket costs for any item or service that is unlikely to be covered by insurance. This includes services not covered by the patient’s insurance plan and services that may have cost-sharing obligations, such as deductibles or copayments. 

Providing patients with a GFE is crucial for several reasons:

• Transparency and Patient Empowerment: GFEs empower patients with information about the potential costs of their care, allowing them to make informed decisions about their treatment options.
• Compliance with Federal Law: Failure to comply with the No Surprises Act can result in significant fines and penalties.  
• Improved Patient Satisfaction: Providing patients with a clear understanding of their financial responsibility can enhance their trust and satisfaction with your practice.

To ensure compliance with the No Surprises Act:

• Develop a standardized GFE² template: Create a clear and concise GFE that includes all required information, such as the patient’s name, the date of service, a description of the item or service, the provider’s name and contact information, and the estimated cost.
• Provide the GFE to patients in a timely manner: The GFE must be provided to the patient at least one business day before the scheduled service.
• Maintain accurate records: Keep detailed records of all GFEs provided to patients, including the date the GFE was provided and any patient acknowledgment of receipt.

Go beyond the GFE with transparency in billing. Have best practices in place for providing clear and itemized bills, explaining codes and charges, and offering flexible payment options. Flexible payment options can include a recurring payment system or saving cards on file to schedule a payment most convenient to the patient.

By understanding and complying with the No Surprises Act, chiropractors can minimize their risk of legal and financial penalties while enhancing patient satisfaction and trust.  

Broader Risk Management Strategies

Staff Training: 

A well-trained staff is a crucial component of risk management in any chiropractic practice. All staff members, from receptionists to billing specialists, should receive comprehensive training on risk management procedures. This training should include:

• HIPAA Compliance³: Staff must be well-versed in the Health Insurance Portability and Accountability Act (HIPAA), which sets the standard for protecting sensitive patient data. They should understand the privacy, security, and disclosure rules of protected health information (PHI).  
• Patient Confidentiality: Staff should be trained on maintaining patient confidentiality beyond HIPAA requirements. This includes understanding the importance of discreet conversations, secure record keeping, and proper handling of patient information both in physical and electronic formats.
• Emergency Protocols: All staff members should be prepared to handle emergencies. Training should cover basic first aid and CPR, procedures for different medical emergencies, and how to contact emergency services effectively.

Cybersecurity⁴: In today’s increasingly digital world, protecting electronic patient data from cyber threats is essential. Chiropractic practices must prioritize cybersecurity measures to ensure patient information’s confidentiality, integrity, and availability. Key measures include:

• Data Encryption: Encrypting patient data both in transit and at rest helps protect it from unauthorized access. This includes using secure email systems, encrypting hard drives and portable devices, and employing secure cloud storage solutions.
• Secure Password Management: Strong passwords and multi-factor authentication are vital for securing access to patient data. Staff should be trained to create strong passwords, change them regularly, and avoid common password mistakes.
• Data Security Training: Regular training for all staff members on data security protocols is crucial. This training should cover topics like recognizing phishing scams, avoiding suspicious links and attachments, and best practices for handling sensitive information.

Proactive risk management strategies are essential for long-term success. Regular internal audits of your treatment plans, documentation, and financial records allow you to identify and address potential risk areas before they become significant issues. Seeking guidance from legal and financial professionals in the healthcare industry can help ensure your practice complies with all relevant laws and regulations. Maintaining adequate professional liability insurance provides a crucial safety net, protecting your practice from potential malpractice claims related to treatment decisions and financial disputes.  

By prioritizing clear treatment planning, transparent financial policies, and proactive risk management strategies, chiropractors can enhance patient care, improve practice efficiency, and protect their professional and financial well-being.

¹ https://www.cms.gov/nosurprises

² https://www.acatoday.org/advocacy/no-surprises-act-of-2022/

³ https://www.hhs.gov/hipaa/index.html

⁴ https://www.nist.gov/cyberframework